Subclinical systemic and vascular inflammation detected by ¹⁸F‐fluorodeoxyglucose positron emission tomography/computed tomography in patients with mild psoriasis

Abstract

Severe psoriasis is a systemic inflammatory disease involving major arteries and internal organs. The association between psoriasis and arterial inflammation, however, has been noted mostly in patients with moderate to severe psoriasis. Therefore, it is still not clear whether mild psoriasis also increases the arterial inflammation and cardiovascular disease. In this study, we aimed to investigate systemic inflammation using 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in patients with mild psoriasis. In a nested case-control study, FDG-PET/CT findings of 10 patients with mild chronic plaque psoriasis involving a body surface area of less than 5% were compared with those of 10 age-and sex-matched healthy controls. The degree of FDG uptake in the large arteries (ascending aorta, aortic arch, descending aorta, suprarenal abdominal aorta and infrarenal abdominal aorta,) and liver were analyzed using the maximum target-to-background ratios (TBR). There were no significant demographic differences between the psoriasis patients and the control subjects (P > 0.05). Patients with psoriasis showed higher maximum TBR than healthy controls in all examined arterial segments, with statistical significance reached in the suprarenal abdominal aorta (P < 0.05), ascending thoracic aorta (P < 0.01) and infrarenal abdominal aorta (P < 0.05), and in the liver (P < 0.05). The "candy cane sign", which represents typical arterial inflammation of the thoracic aorta, was noted upon PET in the majority of psoriasis cases. In conclusion, mild psoriasis is also associated with arterial and hepatic inflammation, which can be readily demonstrated by using FDG-PET/CT.

Cardiovascular and Metabolic Diseases Comorbid with Psoriasis: Beyond the Skin

“…All of these conditions increase the risk for the development of type 2 diabetes and cardiovascular disease (67-69) (Figure). Consistent with this hypothesis, subclinical systemic and vascular inflammation have been detected by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with psoriasis (70). In a six-month prospective study, carotid arterial stiffness in patients with psoriasis was significantly improved by anti-TNF-α therapy (71).…”

Management of psoriasis as a systemic disease: what is the evidence?

“…Observations from 18 F‐fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) studies also validate the hypothesis that psoriasis is a systemic inflammatory disease. In these studies, patients with moderate‐to‐severe psoriasis demonstrate subclinical inflammation in the liver, joints and tendons, in addition to significantly increased global arterial and subcutaneous inflammation, and patients with mild psoriasis had subclinical inflammation in the aorta . Also, ultrasound of femoral arteries can improve detection of subclinical atherosclerosis in patients with moderate‐to‐severe psoriasis and insulin resistance helps to provide a better prediction of subclinical atherosclerosis than traditional CVD risk factors .…”

Impact of adalimumab treatment on cardiovascular risk biomarkers in psoriasis: Results of a pilot study

“…Different authors observed higher common carotid artery intima‐media thickness (IMT) in patients with severe psoriasis compared with control subjects, while others measured various cardiovascular biomarkers . Interestingly, even in patients with mild psoriasis subclinical systemic and vascular inflammation detected by 18 F‐fluorodeoxyglucose positron emission tomography (FDG‐PET)/computed tomography (CT) has been described . Systemic therapy for psoriasis, for example, methotrexate or tumor necrosis factor‐α inhibitors (anti‐TNF‐α), seems to be an effective approach to decrease cardiovascular events in psoriasis patients .…”